The Determination of Appendicitis from Folate Acid and Vascular Endothelial Growth Factor Level in Animal Model: A Review

Abstract

BACKGROUND: Appendicitis is one of the most common abdominal emergencies that require surgery in children. The morbidity and mortality rate in appendicitis is greatly affected by rupture or leakage of the appendix. In establishing the diagnosis of appendicitis, several modalities are acknowledged, namely, pediatric appendicitis score and ultrasound. Pathologically, severity and complications of appendicitis occur related to good vascularization and tissue healing process through process of angiogenesis influenced by folic acid (FA) and vascular endothelial growth factor (VEGF). This is clinically important as currently non-operative and non-invasive therapies were developing in stratification of mild appendicitis. AIM: This study aimed to review the determination of appendicitis from FA and VEGF levels in animal model. METHODS: This study was conducted in accordance with the PRISMA guidelines for reporting systematic reviews. Articles were reviewed for relation of FA and VEGF in determining appendicitis in PubMed and Science Direct. Articles on experimental animal model published from 1990 to 2020 were included, while articles in English were excluded from the study. RESULTS: The articles we reviewed conduct an assessment of appendicitis by FA and VEGF level in animal model. Three articles were reviewed ranging from 1990 to 2020. One article presented a significant association of decreased level of FA in determining appendicitis while the other two mentioned trends of decreased level of FA and VEGF in appendicitis without statistically significance. CONCLUSION: Reduction of folate acid levels could be a critical prescient factor for the weight of muddled an appendicitis in animal model, however, there was a pattern demonstrating low estimation of VEGF as an indicator of appendicitis and convoluted appendix with no measurable note worthiness appeared.

Endothelial Dysfunction in Appendicitis

“…This mechanism relates the VGEF to be believed associated with complicated appendicitis. Further evidence presented that different expression of VEGF may be found on histopathological examination of microvessel density in appendicitis specimens [28,29].…”

“…Further analysis reveals that folic acid (FA) assumed a role in mucosal opposition and its capacity to recover, and VEGF (explicitly found in vein endothelial cells) was associated in tissue remodeling through a cycle of neovascularization, reepithelization, and guide of extracellular framework and has an important pro-angiogenic activity, having a mitogenic and an anti-apoptotic effect on endothelial cells, increasing the vascular permeability, promoting cell migration, etc. Due to these effects, it actively contributes in regulating the normal and pathological angiogenic processes [29].…”

“…A low folate acid serum and raised homocysteine was shown to be found among patients with constant provocative infections and conditions such as systemic inflammatory illness and endothelial damage. A higher folate level would prevent endothelial damage as it would help maintain levels of homocysteine, vasodilators, and nitric oxide [28,29,36].…”